Abstract Body: Background
There is an unmet need to better understand the likelihood of a good functional outcome in older and frailer populations undergoing endovascular therapy (EVT) following large-vessel occlusion (LVO) ischemic stroke. One approach is to improve the understanding of pre-morbid brain health (“brain frailty”) as a predictor of functional outcome. This study explored the relationship between the spatial pattern of brain atrophy and functional outcome to determine whether this is a predictor of outcomes following EVT.
Methods
Patients with LVO from four hospitals in Europe and the USA were included. Three cohorts were used as a derivation cohort, and the fourth served for validation. Presenting CT imaging was processed using Brainomix in-house software to automatically localize and quantify atrophy (frailty-index). Masks from the derivation cohort were used to localize regions of atrophy significantly associated with poorer functional outcome (modified Ranking Scale 3-6) using a voxel-based, multivariate method (Sparse Canonical-Correlation-Analysis) (see Figure 1). For both derivation and validation cohorts, the degrees of overlap between each patient’s atrophy mask and the regions associated at a group level with poor outcome were calculated. This was used as an independent predictor of functional outcome in multivariate analysis adjusting for overall brain frailty-index, recanalization status, and ASPECT score
Results
The derivation cohort consisted of 658 patients (mean age 69.6±15.0, median ASPECTS 9 [7-10]), while the validation cohort consisted of 447 patients (mean age 64.7 ±15.5, median ASPECTS 8 [5-10] ). Atrophy localized to the lateral ventricles and sylvian fissure was significantly associated with poorer outcomes (Figure 1). In both derivation and validation cohort, the presence of this spatial pattern of brain frailty (quantified using the degree of overlap) was an independent predictor of poor functional outcome (Table 1).
Conclusion
A better understanding of pre-stroke brain health, such as the distribution of atrophy, may provide additional information to inform the prediction of outcome following LVO. This could improve patient selection for treatment following ischemic stroke through better prognostication and a more personalized approach to decision making.